Method of implanting a bone fixation assembly

ABSTRACT

A bone fixation assembly can include a suture button, a bone plate, and a suture assembly. The suture button can include a body that has a first end surface, a second end surface, and a circumferential outer surface. A first pair of passages can be formed through the body from the first end surface to the second end surface. The circumferential outer surface can include at least one protrusion or retaining rib extending radially therefrom. The bone plate defines an aperture. The suture button is configured to be at least partially received into the aperture in an assembled position such that the retaining rib engages the bone plate and inhibits withdrawal of the suture button from the aperture in the assembled position. The suture assembly includes a suture engaging member and a suture configured to couple the suture engaging member in the suture button.

CLAIM OF PRIORITY

This application is a divisional of U.S. patent application Ser. No. 13/342,646, filed on Jan. 3, 2012, the benefit of priority of which is claimed hereby, and which is incorporated by reference herein in its entirety.

FIELD

The present disclosure relates generally to bone fixation and more particularly, to a clavicle fixation assembly including a suture button, a bone plate, and a suture assembly that are used in combination to position a clavicle at a desired location relative to a scapula.

BACKGROUND

This section provides background information related to the present disclosure which is not necessarily prior art.

Portions of the anatomy can generally be formed relative to one another to allow for a natural articulation, support, movement, or the like. Nevertheless, due to various circumstances, such as injury, disease, or the like, various portions of the anatomy can become damaged. For example, a bone portion and/or surrounding tissue may become damaged in a manner that is substantially unnatural. It may be selected to perform a procedure relative to the bone portion to recreate the more natural bone portion.

For example, in some instances, a clavicle can become partially or completely fractured causing the clavicle, in some instances, to become misaligned relative to the surrounding anatomy including a coracoid process of a scapula. In some instances, coracoclavicular ligaments that connect between the clavicle and coracoid process can tear, causing a clavicle to unfavorably displace superiorly. In some circumstances, it may be difficult to properly locate the clavicle relative to a scapula.

SUMMARY

This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features.

A bone fixation assembly can include a suture button, a bone plate, and a suture assembly. The suture button can include a body that has a first end surface, a second end surface, and a circumferential outer surface. A first pair of passages can be formed through the body from the first end surface to the second end surface. The circumferential outer surface can include at least one protrusion or retaining rib extending radially therefrom. The bone plate defines an aperture. The suture button is configured to be at least partially received into the aperture in an assembled position such that the retaining rib engages the bone plate and inhibits withdrawal of the suture button from the aperture in the assembled position. The suture assembly includes a suture engaging member and a suture configured to couple the suture engaging member in the suture button.

According to additional features, the suture button can further define a second pair of passages formed through the body from the first end surface to the second end surface. The body can also define a pair of radial openings that connect the second pair of passages, respectively with the circumferential outer surface. The suture button can further define a central passage. The first and second pair of passages can be located radially outwardly on the body relative to the central passage.

According to other features, the button can have a body that has an upper portion having a first diameter and a lower portion having a second diameter. The first diameter can be larger than the second diameter. The retaining rib can be formed on the lower portion. In one example, the first pair of passages taper toward each other from the first end surface to the second end surface. The lower portion can be configured to be received at least partially into the aperture of the bone plate and the upper portion can be configured to extend proud from the bone plate in the assembled position.

According to some examples, each passage of the first pair of passages is further defined by a chamfer surface that connects the first end surface with a radial sidewall. The aperture in the bone plate can be threaded such that the retaining rib positively engages the threads in the assembled position. The suture engaging member can comprise an elongated member having a passage formed therethrough. The suture can be configured to be looped through the passage in the suture engaging member. The elongated member can be configured to engage a bone in the assembled position such that the elongated member is inhibited from moving toward the suture button. In other examples, the elongated member can comprise a flexible tube that defines the passage. The flexible tube can be configured to expand and engage the bone in the assembled position.

A method of implanting a bone fixation assembly includes preparing a first hole through a clavicle. A second hole can be prepared through a coracoid process. A bone plate having an aperture can be positioned against the clavicle. A portion of suture can be located through the aperture, the first hole, and the second hole until a retaining member slidably disposed on the portion of suture locates against an outer surface of the coracoid process. A second portion of the suture can be passed through an aperture defined in the suture button. The suture button can be positively located into the bone plate aperture. The second portion of suture can be drawn away from the outer surface of the coracoid process causing tension between the retaining member and the bone plate. The second portion of the suture can be secured at a position that maintains the tension.

In some examples, positively locating the suture button includes engaging retaining ribs formed on a circumferential surface of the suture button with threads formed in the bone plate at the aperture. Drawing the second portion of the suture away from the outer surface of the coracoid process can include manipulating the retaining member from a first position that has an outer profile generally suitable to pass through the first and second holes to a second position that has an outer profile generally unsuitable to pass through the first and second holes.

Further areas of applicability will become apparent from the description provided herein. The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only of selected embodiments and not all possible implementations, and are not intended to limit the scope of the present disclosure.

FIG. 1 is a posterior perspective view of a bone fixation assembly constructed in accordance to one example of the present teachings and shown in an implanted position relative to a right clavicle and scapula of a patient;

FIG. 2 is an exploded perspective view of the bone fixation assembly of FIG. 1 and shown relative to a clavicle, coracoid process, and acromion;

FIG. 3 is a superior plan view of the bone fixation assembly of FIG. 1;

FIG. 4 is a cross-sectional view of the bone fixation assembly taken along line 4-4 of FIG. 3;

FIG. 5 is a plan view of an exemplary bone plate of the bone fixation assembly;

FIG. 6 is a perspective view of a bone plate constructed in accordance with additional features of the present teachings;

FIG. 7 is a front perspective view of a suture button constructed in accordance to one example of the present teachings;

FIG. 8 is a plan view of the suture button of FIG. 7;

FIG. 9 is a cross-sectional view of the suture button taken along line 9-9 of FIG. 8;

FIG. 10 is a perspective view of another suture button constructed in accordance to other features of the present teachings;

FIG. 11 is a plan view of the suture button of FIG. 10;

FIG. 12 is a cross-sectional view of the suture button taken along lines 12-12 of FIG. 11;

FIG. 13 is a cross-sectional view of the suture button shown in FIG. 7 in an assembled position relative to the bone plate of FIG. 5;

FIG. 14 is a cross-sectional view of the suture button of FIG. 10 shown in an assembled position relative to the bone plate of FIG. 5;

FIG. 15 is an exploded view of a bone fixation assembly constructed in accordance to another example of the present teachings that incorporates the suture button of FIG. 11 and an alternate suture engaging member;

FIG. 16 is a cross-sectional view of the bone fixation assembly of FIG. 15 and shown with an insertion tool passing the elongated member through a first hole in the clavicle and a second hole through the coracoid process during an implantation step;

FIG. 17 is a cross-sectional view of the bone fixation assembly shown in FIG. 16 and shown with the insertion tool removed and the suture tied in an implanted position; and

FIG. 18 is an exploded perspective view of a bone fixation assembly that incorporates a suture configuration according to additional features.

Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference to the accompanying drawings.

The following description of the various embodiments is merely exemplary in nature and is in no way intended to limit the teachings, their application or uses. While the following description is directed toward an apparatus and method for fixing a right clavicle relative to a coracoid process of a scapula and other surrounding anatomy of a patient, it would be appreciated that the same may be applied to fixation of a left clavicle. In this regard, the apparatus disclosed herein may be used in other implants including those that incorporate a bone plate. For example, the apparatus disclosed herein may be incorporated in a periprosthetic situation where using a bone screw may be insufficient or unfavorable such as when a far cortex may not adequately support the threads of the bone screw.

With initial reference to FIGS. 1-3, a bone fixation assembly constructed in accordance with one example of the present teachings is shown and generally identified at reference numeral 10. The bone fixation assembly 10 is shown in an implanted position in FIGS. 1 and 3. Briefly, a patient's anatomy can include a clavicle 12 and a scapula 14 having a coracoid process 16 and acromion 18. The clavicle 12 and acromion 18 can cooperate to form an articulating portion such as the acromioclavicular joint 20. Various ligaments can connect the clavicle 12 with portions of the scapula 14 such as coracoclavicular ligaments 22 (FIG. 2) that are connected between the clavicle 12 and the coracoid process 16. The clavicle 12 is illustrated having a fracture 26. Additionally, or alternatively, the coracoclavicular ligaments 22 can be torn. Such conditions can unfavorably cause the clavicle 12 to move generally superiorly and posteriorly relative to the coracoid process 16. As will become appreciated from the following description, the bone fixation assembly 10 according to the present teachings, once implanted, can generally fix the clavicle 12 back to a desired position such that the unfavorable superior/posterior deflection of the clavicle can be reduced as well as re-approximate fractured clavicle 12 for healing.

With continued reference to FIGS. 1-3 and additional reference to FIGS. 4 and 5, the bone fixation assembly 10 will be further described. The bone fixation assembly 10 can generally include a bone plate 30, a suture button 32, and a suture assembly 34 including a suture 36 and a suture engaging member 38. The bone plate 30 can generally include an elongated plate body 42 having a sloped circumferential surface 44. The elongated plate body 42 can further include an outer surface 46 and an opposite bone engaging surface 48 (FIG. 4). A plurality of threaded apertures 50 can be formed through the bone plate 30 from the outer surface 46 to the bone engaging surface 48. A threaded aperture 52 can be located generally centrally on the bone plate 30. The threaded aperture 52 can be formed similar to the threaded apertures 50. In this regard, the threaded aperture 52 includes threads 54 formed thereon. It will be appreciated that the shape and configuration of the bone plate 30 is merely exemplary and that other bone plates may be used within the scope of the present teachings. Bone screws 56 may be threaded into the threaded apertures 50 as needed to engage bone and/or tissue beyond the bone engaging surface 48 of the bone plate 30. In some examples, the bone plate 30 may additionally or alternatively incorporate non-threaded holes and/or slots that can each cooperatively receive a suture button 32 (or other suture buttons having different configurations).

Referencing now FIG. 6, a bone plate 30′ constructed in accordance to additional features of the present teachings is shown. The bone plate 30′ can include similar features as the bone plate 30 described above. In this regard, the bone plate 30′ can include an elongated plate body 42′ having threaded apertures 50′. A threaded aperture 52′ located generally in the center of the bone plate 30′ can collectively define multiple overlapping threaded apertures. In this regard, the threaded aperture 52′ can provide the surgeon with additional versatility for locating a suture button 32 during implantation.

With particular reference now to FIGS. 7-9, the suture button 32 will be described in greater detail. The suture button 32 generally comprises a body 60 that includes a first end surface 62, a second end surface 64, and a circumferential outer surface 66. A first pair of passages 70 are formed through the body 60 from the first end surface 62 to the second end surface 64. A second pair of apertures 74 are formed through the body 60 from the first end surface 62 to the second end surface 64. The first pair of passages 70 are generally defined by a first pair of radial sidewalls 78 and a corresponding pair of chamfer surfaces 80 that connect the radial sidewall 78 with the first end surface 62. Similarly, the second pair of apertures 74 can be generally defined by a corresponding pair of radial sidewalls 82 and a pair of chamfer surfaces 84 that generally connect the radial sidewalls 82 with the first end surface 62. The body 60 can generally define a pair of radial openings 88 that are formed through the circumferential outer surface 66 and connect with the second pair of apertures 74. As will become appreciated, the first and second pair of passages 70 and 74 can be configured to accept the suture 36 therethrough when securing the suture assembly 34 to the suture button 32. The radial openings 88 can offer a surgeon radial access for the suture 36 to the second pair of apertures 74.

A central passage 90 is formed through the body from the first end surface 62 to the second end surface 64. The central passage 90 can generally be defined by a central radial sidewall 92 and a corresponding central chamfer surface 94. A plurality of radial protrusions or retaining ribs 98 extend from the circumferential outer surface 66. In the example shown, six pair of discontinuous and equally spaced retaining ribs 98 are positioned around the circumferential outer surface 66. As will be described herein, the retaining ribs 98 can be configured to positively locate and engage the threads 54 formed on the bone plate 30 in an assembled position. It will be appreciated that in other configurations the retaining ribs 98 can engage other features incorporated on the bone plate 30 such as a groove or chamfer. It other examples, the suture button 32 may be configured without the retaining ribs 98.

Returning now to FIG. 2, the suture assembly 34 will now be described according to one example. The suture engaging member 38 illustrated in FIG. 2 can generally define an elongated body 104 having a first eyelet 106 and a second eyelet 108. In general, the suture engaging member 38 can have a profile that can be advanced through a first bone hole 110 prepared in the clavicle 12 and a second bone hole 112 prepared in the coracoid process 16. In the particular example shown, the suture engaging member 38 is in the form of a ToggleLoc™ offered by Biomet Sports Medicine, LLC of Warsaw, Ind. Additional features and description of the ToggleLoc™ may be found in commonly owned U.S. Pat. No. 7,500,983, which is expressly incorporated herein by reference. Other retaining members may be additionally or alternatively used to locate the suture 36 relative to the coracoid process 16.

With particular reference now to FIG. 4, one example of implanting the bone fixation assembly 10 according to the present teachings will be described. Initially, the preferred orientation and location of the bone plate 30 will be assessed by the surgeon. Similarly, a properly sized component of the bone fixation assembly 10 for the particular patient and injury to be treated can be selected.

The first bone hole 110 can then be prepared through the clavicle 12. The second bone hole 112 can then be prepared through the coracoid process 16. The bone plate 30 can then the positioned against the clavicle 12 such that the bone engaging surface 48 engages the clavicle 12. The suture engaging member can then be advanced through the first and second bone holes 110 and 112 and rotated generally into the position illustrated in FIG. 4 where the elongated body 104 can generally engage an outer surface of the coracoid process 16 and fix a first portion of suture 36. A second portion of the suture 36 can then be located through any combination of the first and second pairs of passages 70 and 74 of the suture button 32.

The suture button 32 can be advanced at least partially into the threaded aperture 52 until the retaining ribs 98 engage the threads 54 or other feature on the bone plate 30. It is contemplated that the retaining ribs 98 can achieve a snap fit or otherwise attain a fixed relationship relative to the bone plate 30. The suture 36 can then be tied as illustrated at reference number 120. It is contemplated that the sequence of steps may be altered as needed. For example, a surgeon may advance the suture button 32 into the threaded aperture 52 concurrently while tying the knot 120. The arrangement of the bone fixation assembly 10 of the present teachings provides a surgeon the ability to capture and fix a length of clavicle 12 that may have a fracture 26 while concurrently offering a tension and retaining force between the clavicle 12 and the coracoid process 16 with one fixation assembly. Such an arrangement can also be particularly advantageous when addressing a clavicle 12 that has torn or damaged coracoclavicular ligaments 22. It is contemplated that the bone fixation assembly 10 may be offered in a pre-packaged kit.

With reference now to FIGS. 10-12, a suture button 132 constructed in accordance to additional features of the present teachings will be described. The suture button 132 can include similar features as discussed above with respect to the suture button 32. The suture button 132 can have a body 133 that includes an upper portion 134 and a lower portion 136 (see FIG. 12). The upper portion 134 can have an upper diameter 138 while the lower portion 136 can have a lower diameter 140. The upper diameter 138 can be greater than the lower diameter 140 such that the upper portion 134 can sit proud relative to an outer surface 46 of the bone plate (see FIG. 14). The body 133 can generally include a first end surface 142 and a second end surface 144. Radial protrusions or retaining ribs 146 can be formed around a circumferential surface 148 of the lower portion 136.

Two pairs of passages 150 can be formed through the body 133 from the first end surface 142 to the second end surface 144. A central passage 154 can be formed through the body 133 from the first end surface 142 to the second end surface 144. Each passage 150 can have an axis 160 that defines an angle 162 relative to an axis 164 of the central passage 154. The passages 150 are defined by a pair of radial sidewalls 170 (FIG. 12) and a corresponding pair of chamfer surfaces 172 (FIG. 11) that connect the radial sidewall 152 with the first end surface 142. The passages 150 generally taper inwardly from the first end surface 142 to the second end surface 144. Such a configuration can offer a surgeon more space to manipulate suture extending from the passages 150 as well as maneuver a rod 180 of a insertion tool 182 (as is described herein with respect to FIGS. 15-17).

Turning now to FIGS. 15-17, a bone fixation assembly 210 constructed in accordance to additional features of the present teachings will be described. The bone fixation assembly 210 generally includes the bone plate 30, the suture button 132, and a suture assembly 212 that includes a suture engaging member 214 and a suture 216. It is appreciated that while the bone fixation assembly 210 is described herein as being associated with the suture button 132, the suture button 32 can be also used. Similarly, while the suture engaging member 214 will be described as associated with the embodiment of FIGS. 15-17, the suture engaging member 38 can alternatively be used. The suture engaging member 214 can generally include an elongated member 217 having a flexible tube 218 that defines a passage 220 therethrough. In one example, the suture engaging member 214 can include a JuggerKnot™ Soft Anchor offered by Biomet Sports Medicine, LLC of Warsaw, Ind.

The insertion tool 182 can generally include a handle 222 that is connected to the rod 180. During use, once a first bone hole 110 has been prepared in the clavicle 12 and the second bone hole 112 has been prepared in the coracoid process 16, a distal end 224 of the rod 180 can be used to pass the suture engaging member 214 with a portion of suture 216 through the first bone hole 110 of the clavicle 12 and the second bone hole 112 of the coracoid process 16 until the suture engaging member 214 extends out of the second bone hole 112 of the coracoid process 16 (FIG. 16). Next, the insertion tool 182 can be withdrawn from the coracoid process 16 and the clavicle 12. A second portion of the suture 216 can be located as desired through respective passages 150 in the suture button 132. The suture 216 then can be pulled causing the flexible tube 218 of the suture engaging member 214 to generally expand to a position shown in FIG. 17 and inhibit the suture 216 from being withdrawn through the second bone hole 112 of the coracoid process 16. The suture 216 can then be tied at reference numeral 250 as shown in FIG. 17. The suture button 132 can then be advanced at least partially into the threaded aperture 52 causing the retaining ribs 146 to positively lock with the threads 54 of the threaded aperture 52. Again, it will be appreciated that the sequence of steps are exemplary and may be altered as needed. It will be appreciated that the desired amount of tension can be applied to the suture 216 causing the clavicle 12 to be moved to a desired orientation.

Turning now to FIG. 18, a bone fixation assembly 310 constructed in accordance to additional features of the present teachings will be described. The bone fixation assembly 310 generally includes the bone plate 30, the suture button 132, and a suture assembly 312. The suture assembly 312 can include a ZipLoop™ suture configuration offered by Biomet Sports Medicine, LLC of Warsaw, Ind. The ZipLoop™ may be threaded for use with the passages 150 formed through the body 133 of the suture button 132. The suture assembly 312 may cooperate with a suture engaging member such as the suture engaging member 38 shown in FIG. 4 (FIG. 4) described above. Additional description of the ZipLoop™ and its operation may be found in commonly owned U.S. Pat. No. 7,658,751, issued on Feb. 9, 2010; U.S. Pat. No. 7,601,165, issued on Oct. 13, 2009; and pending U.S. application Ser. No. 12/719,337, filed on Mar. 18, 2010, which are all expressly incorporated herein by reference.

The foregoing description of the embodiments has been provided for purposes of illustration and description. It is not intended to be exhaustive or to limit the disclosure. Individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but, where applicable, are interchangeable and can be used in a selected embodiment, even if not specifically shown or described. The same may also be varied in many ways. Such variations are not to be regarded as a departure from the disclosure, and all such modifications are intended to be included within the scope of the disclosure. 

What is claimed is:
 1. A method of implanting a bone fixation assembly, the method comprising: positioning a portion of a suture through an eyelet in a suture engaging member to form first and second suture strands extending from opposite sides of the eyelet, the suture engaging member being elongated along a longitudinal direction; advancing the suture engaging member in a longitudinal orientation through a bone plate aperture in a bone plate, through a clavicle hole in a clavicle, and through a coracoid process hole in a coracoid process, so that the first and second suture strands extend from the eyelet sequentially through the coracoid process hole, the clavicle hole, and the bone plate aperture; advancing a suture button over the first and second suture strands into the bone plate aperture; securing the suture button to the bone plate by engaging retaining ribs formed on a circumferential surface of the suture button with one or more threads formed in the bone plate at the bone plate aperture; pulling on the first and second suture strands to: pivot the suture engaging member away from the longitudinal orientation so that the suture engaging member has an outer profile unsuitable for entering the coracoid process hole, and produce tension between the suture engaging member and the bone plate; and tying the first and second suture strands together to maintain the tension.
 2. The method of claim 1, wherein the first and second suture strands extend through respective first and second longitudinal passages in the suture button.
 3. The method of claim 2, wherein the first and second passages are positioned on opposite sides of a longitudinal axis of the suture button.
 4. The method of claim 3, wherein the first and second passages are radially accessible through a lateral edge of the suture button.
 5. The method of claim 3, wherein the first and second passages are radially inaccessible through a lateral edge of the suture button.
 6. The method of claim 1, wherein: the first and second suture strands extend through a single longitudinal passage in the suture button; and the first and second suture strands are tied together in a knot that is too large to fit in the single longitudinal passage.
 7. The method of claim 1, wherein the retaining ribs are discontinuous around the circumference of the suture button.
 8. The method of claim 1, wherein the retaining ribs are arranged in groups around the circumference of the suture button, the ribs in each group being longitudinally offset from one another.
 9. The method of claim 1, further comprising positioning the bone plate proximate the clavicle.
 10. The method of claim 1, further comprising: preparing the clavicle hole through the clavicle; and preparing the coracoid process hole through the coracoid process.
 11. A method of implanting a bone fixation assembly, the method comprising: locating a portion of a suture through a bone plate aperture in a bone plate, through a clavicle hole in a clavicle, and through a coracoid process hole in a coracoid process, until a retaining member slidably disposed on the portion of the suture locates against an outer surface of the coracoid process; passing a second portion of the suture through a suture button aperture defined in a suture button; positively locating the suture button into the bone plate aperture including engaging retaining ribs formed on a circumferential surface of the suture button with one or more threads formed in the bone plate at the bone plate aperture; drawing the second portion of the suture away from the outer surface of the coracoid process causing tension between the retaining member and the bone plate; and securing the second portion of the suture at a position that maintains the tension.
 12. The method of claim 11, wherein drawing the second portion of the suture away from the outer surface of the coracoid process comprises: manipulating the retaining member from a first position that has an outer profile generally suitable to pass through the clavicle hole and the coracoid process hole to a second position that has an outer profile generally unsuitable to pass through the coracoid process hole.
 13. The method of claim 11, wherein drawing the second portion of the suture away from the outer surface of the coracoid process comprises: manipulating the retaining member from a first position that has an outer profile generally suitable to pass through the clavicle hole and the coracoid process hole to a second position that has an outer profile generally unsuitable to pass through the clavicle hole and the coracoid process hole.
 14. The method of claim 11, further comprising: positioning the bone plate proximate the clavicle; preparing the clavicle hole through the clavicle; and preparing the coracoid process hole through the coracoid process.
 15. The method of claim 11, wherein the retaining ribs are discontinuous around the circumference of the suture button.
 16. The method of claim 11, wherein the retaining ribs are arranged in groups around the circumference of the suture button, the ribs in each group being longitudinally offset from one another.
 17. A method of implanting a bone fixation assembly, the method comprising: preparing a clavicle hole through a clavicle; preparing a coracoid process hole through a coracoid process; positioning a bone plate having an aperture proximate the clavicle; locating a portion of a suture through the aperture, the clavicle hole, and the coracoid process hole, until a retaining member slidably disposed on the portion of the suture locates against an outer surface of the coracoid process; passing a second portion of the suture through an aperture defined in a suture button; positively locating the suture button into the bone plate aperture including engaging retaining ribs formed on a circumferential surface of the suture button with one or more threads formed in the bone plate at the aperture; drawing the second portion of the suture away from the outer surface of the coracoid process causing tension between the retaining member and the bone plate; and securing the second portion of the suture at a position that maintains the tension.
 18. The method of claim 17, wherein drawing the second portion of the suture away from the outer surface of the coracoid process comprises: manipulating the retaining member from a first position that has an outer profile generally suitable to pass through the clavicle hole and the coracoid process hole to a second position that has an outer profile generally unsuitable to pass through the clavicle hole and the coracoid process hole.
 19. The method of claim 17, wherein the retaining ribs are discontinuous around the circumference of the suture button.
 20. The method of claim 17, wherein the retaining ribs are arranged in groups around the circumference of the suture button, the ribs in each group being longitudinally offset from one another. 